NPIMap

Organization Active NPI

Revere Health Center Pharmacy

  • Health Service Clinic/Center
  • Revere, MA
National Provider Identifier
1649363243
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
MA0044987 Issued in MA
Legal business name
REVERE HEALTH CENTER PHARMACY
Practice address
300 Ocean Ave
Revere, MA 02151
Phone
(781) 485-6098
Fax
(781) 485-6042
NPI assigned
Oct 2, 2006
Last updated
Jan 15, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
GENERAL HOSPITAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Karen Marie Ryle, MS RPHNPI 1417008186
Title
Business Unit Leader
Phone
(617) 724-9154

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X MA0044987 MA Primary

Addresses

Primary practice location

300 Ocean Ave
Revere, MA 02151

Mailing address

300 Ocean Ave
Revere, MA 02151
Phone (781) 485-6098

Other identifiers 1

IdentifierTypeStateIssuer
0445533MedicaidMA

National Provider Directory

National Provider Directory
Tax ID family
Psychiatry Consult Serv13 organizations share this tax ID, including this one
Part of
Psychiatry Consult Serv

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1649363243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 OCEAN AVE",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "02151",
            "telephone_number": "781-485-6098",
            "fax_number": "781-485-6042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OCEAN AVE",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "02151",
            "telephone_number": "781-485-6098",
            "fax_number": "781-485-6042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVERE HEALTH CENTER PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENERAL HOSPITAL CORPORATION",
        "enumeration_date": "2006-10-02",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "RYLE",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "BUSINESS UNIT LEADER",
        "authorized_official_telephone_number": "617-724-9154",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS RPH"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MA",
            "license": "MA0044987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445533",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Revere, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.